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NPI Code Detail

MEDICARE: MULTNOMAH COUNTY OREGON

MEDICARE: MULTNOMAH COUNTY OREGON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic Pharmacy
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacyRP-0001123-CSOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22078377OTHERPK

General Provider Information

NPI Number : 1306851191
Entity Type Code : Organization
Provider Name (Legal Business Name) : MULTNOMAH COUNTY OREGON
Provider Business Mailing Address
First Line : 619 NW 6TH AVE FL 7
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3964
Country : US
Telephone Number : 503-988-3608
Fax Number : 503-988-4345
Provider Business Practice Location Address
First Line : 12710 SE DIVISION ST
Second Line :
City : PORTLAND
State : OR
Zip : 97236-3134
Country : US
Telephone Number : 503-988-3608
Fax Number : 503-988-4345
Authorized Official
Title or Position : PHARMACY DIRECTOR
Name : MICHELE KODER
Credential : PHARM D
Telephone Number : 503-988-7278
Provider Enumeration Date : 07/30/2006
Last Update Date : 11/08/2019

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1033219746 — DR. ALYSSA T FRANZEN DMD
Practice Location Address:
12710 SE DIVISION ST
PORTLAND, OR
97236-3134
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Practice Fax:
1457432213 — DR. ERICA S WALDAU D.M.D.
Practice Location Address:
12710 SE DIVISION ST
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97236-3134
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Practice Fax:
1508947102 — DR. MICHELLE C. KEYS DMD
Practice Location Address:
12710 SE DIVISION ST
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97236-3134
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Practice Fax: 503-988-5903

Directions to “MULTNOMAH COUNTY OREGON ” Practice Location

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